After nearly 30 years, the Obama administration wants to modernize the rules nursing homes must follow to qualify for Medicare and Medicaid payments.

The hundreds of pages of proposed changes cover everything from meal times to use of antipsychotic drugs to staffing. Some are required by the Affordable Care Act and other recent federal laws, as well as the president's executive order directing agencies to simplify regulations and minimize the costs of compliance.


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Delta County Memorial Hospital, Urgent Care
Laura Palmisano / KVNF

The federal government has changed the way it pays hospitals through Medicare. It now factors in patient satisfaction. To discuss the affects on a local hospital, KVNF’s Laura Palmisano speaks with Jason Clecker, the CEO of Delta County Memorial Hospital. Over 60 percent of DCHM patients are on Medicare.

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Delta County Memorial Hospital, Urgent Care
Laura Palmisano / KVNF

For the past three years, Delta County Memorial Hospital has been participating in a pilot program that's allowed it to collect more money from Medicaid and Medicare for its services. 

The program will sunset in 2017, but the hospital doesn't want to that to happen. That's why it's lobbying federal lawmakers to support two bills that would extend it.  

Additionally, the hospital wants to see if it can change its classification in effect making those larger payments permanent, but to do that it also needs federal support. 

Lillie Robinson came to Rowan Medical Center for surgery on her left foot. She expected to be in and out in a day, returning weeks later to the Salisbury, N.C., hospital for her surgeon to operate on the other foot.

But that's not how things turned out. "When I got here I found out he was doing both," she said. "We didn't realize that until they started medicating me for the procedure." Robinson signed a consent form and the operation went fine, but she was in the hospital far longer than she'd expected to be.

"I wasn't prepared for that," she said.

Critics of America's health care system say it's really a "sick care" system. Doctors and hospitals only get paid for treating people when they're sick.

But that's starting to change. Health insurance companies and big government payers like Medicare are starting to reward doctors and hospitals for keeping people healthy.

So, many health care companies are trying to position themselves as organizations that help people stay well.

Marty Durlin/KVNF

As the Affordable Care Act takes effect this year, Delta County Memorial Hospital Administrator Jason Cleckler is navigating uncertain terrain.